Role of hypoxia on increased blood pressure in patients with obstructive sleep apnoea.

Okabe, Shinichi; Hida, Wataru; Kikuchi, Yoshihiro; Taguchi, Osamu; Ogawa, Hiroyasu; Mizusawa, Akihito; Miki, Hiroshi; Shirato, Kunio

doi:10.1136/thx.50.1.28

Cited by 37 publications

(28 citation statements)

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“…1-4 Respiratory events during sleep result in acute and transient BP perturbations,5,6 which persist during the daytime. These pathophysiological changes explain the association between OSA and hypertension (HTN) in several large-scale epidemiological studies.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Walia

Rueschman

et al. 2014

Journal of Clinical Sleep Medicine

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Rationale:We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defi ned as ≥ 3 antihypertensives including a diuretic. Defi nitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ≥ 130/80 not on IAR) and resistant elevated BP (BP ≥ 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ≥ 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a fi nding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is characterized by reduction in upper airway muscle tone resulting in repetitive complete (apnea) or partial (hypopnea) upper airway closure during sleep. OSA results in increased sympathetic nervous system activation, changes in baroreceptor function, increased oxidative stress, and endothelial dysfunction, which can increase blood pressure (BP).1-4 Respiratory events during sleep result in acute and transient BP perturbations,5,6 which persist during the daytime. These pathophysiological changes explain the association between OSA and hypertension (HTN) in several large-scale epidemiological studies. 7Elevations in BP including high normal BP often progress to HTN. 8 There are several large-scale epidemiological studies citing the importance of high normal BP and cardiovascular risk. In the Framingham Heart Study, high-normal BP (defi ned as systolic blood pressure of 130-139 or diastolic blood pressure of 85-89 mm Hg) was associated with an approximate 2-fold increased risk factor-adjusted cardiovascular disease (CVD) risk.9 These fi ndings are consistent in cross-ethnic groups. For example, another large prospective study of approximate...

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Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Walia

Rueschman

et al. 2014

Journal of Clinical Sleep Medicine

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“…There are few studies that show acute blood pressure increases following obstructive sleep apnea periods. 22,23 According to the data of the current study, hourly changes in AHI (increase or decrease) during sleep did not result in immediate changes of blood pressure. In other words, acute changes of AHI while sleeping do not cause immediate blood pressure changes.…”

Section: Discussionmentioning

confidence: 99%

Acute Effect of Apnea and Hypopnea Attacks on Blood Pressure During Sleep

Özgür¹,

Bilgin²,

Yazıcı³

et al. 2016

Turkiye Klinikleri J Intern Med

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The present study aimed to investigate whether or not apneic and hypopneic attacks can cause acute blood pressure changes. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 82 patients with symptoms of obstructive sleep apnea were included in the study. A full overnight polysomnography was performed in the sleep laboratory. At the same time, 24-hour ambulatory blood pressure was monitored in all patients. Total apnea and hypopnea attacks between 23.00 and 07.00 hours were counted for each hour. All blood pressure levels were recorded and then compared for each sleep hour. Assessment was made as to whether or not immediate changes in apnea and hypopnea attacks affected the blood pressure. R Re es su ul lt ts s: : The mean systolic blood pressure was 128.90±3.293 of the patients. The mean diastolic blood pressure was 77.29±0.98 mmHg. The mean heart rate was 72.68±0.77. The mean apnea hypopnea index (AHI) was 31.4±3.78. Systolic blood pressure, diastolic blood pressure, heart rate and AHI were recorded each hour independently and the mean values during the hours of sleep were compared statistically. The hourly changes of mean AHI (increase or decrease) did not correlate with the hourly changes of mean systolic blood pressure, mean diastolic blood pressure or mean heart rates (p=0.012). C Co on nc cl lu us si io on n: : No acute changes between AHI and blood pressure were observed during the study.K Ke ey y W Wo or rd ds s: : Sleep apnea, obstructive; hypertension; blood pressure monitoring, ambulatory Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada uyku esnasında oluşan apne ve hipopne ataklarının akut kan basıncı değişikliklerine yol açıp açmadığının tespiti amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya tıkayıcı uyku apnesi semptomları ile Medicana Samsun Hastanesine başvuran 82 hasta dâhil edilmiştir. Tüm hastalara anamnez ve fizik muayeneyi takiben uyku laboratuvarında tüm gece polisomografik uyku testi ve 24 saatlik ambulatuar kan basıncı ölçümü yapılmıştır. Gece 23.00 ile sabah 07.00 saatleri arasındaki total apne ve hipopne atakları saatlik olarak ölçülmüştür. Eş zamanlı saatlik kan basınç-ları da kaydedilmiş ve her saat için kıyaslanmıştır. Böylelikle saatlik apne ve hipopne sayılarının değişiminin kan basıncı değişimine yol açıp açmadığı araştırılmıştır. B Bu ul lg gu ul la ar r: : Çalışmaya katılan hastaların ortalama sistolik kan basıncı 128,90±3,293, ortalama diastolik kan basıncı ise 77,29±0,98 mmHg idi. Ortalama kalp hızı 72,68±0.77, ortalama apne hipopne indeksi ise (AHI) 31,4±3,78 olarak tespit edildi. Sistolik kan basıncı, diastolik kan basıncı, kalp hızı ve AHI, her saat için bağımsız olarak ölçüldü. Ölçülen bu değerlerde saatlik sistolik ve diastolik tansiyon ortalamaları, saatlik AHI ile kıyaslanmıştır. Çalışmada saatlik apne ve hipopne ataklarının değişiminin (artış veya azalış) kan basıncı değişimleri ile ilişkili olmadığı saptanmıştır (p=0,012). Aynı zamanda apne ve hipopneye bağlı kan basınçlarında d...

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“…Mean BP following an obstructive apnea has been shown to increase by 32 mmHg during NREM and 42 mmHg during REM sleep. 15 Similarly, two studies both reported BP surges . 20 mmHg.…”

Section: Hemodynamic Effects Of Osamentioning

confidence: 99%

Hypertension and obstructive sleep apnea

Phillips

Somers

2003

Current Science Inc

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Obstructive sleep apnea (OSA) is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.

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Role of hypoxia on increased blood pressure in patients with obstructive sleep apnoea.

Cited by 37 publications

References 20 publications

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Acute Effect of Apnea and Hypopnea Attacks on Blood Pressure During Sleep

Hypertension and obstructive sleep apnea

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